I 

114TH CONGRESS 

1ST SESSION H. R. 4059 

To amend title XVIII of the Social Security Act to encourage Medicare 

beneficiaries to voluntarily adopt advance directives guiding the medical 

care they receive. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 18, 2015 

Mrs. BLACK (for herself, Mr. WELCH, Mr. THOMPSON of California, and Mr. 

COLLINS of New York) introduced the following bill; which was referred 

to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined 

by the Speaker, in each case for consideration of such provisions as fall 

within the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to encourage 

Medicare beneficiaries to voluntarily adopt advance directives guiding the medical care they receive. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicare Choices Em5 powerment and Protection Act’’. 


tkelley on DSK3SPTVN1PROD with BILLS
2 

•HR 4059 IH

1 SEC. 2. MEDICARE ADVANCE DIRECTIVE CERTIFICATION 

2 PROGRAM. 

3 Part B of title XVIII of the Social Security Act (42 

4 U.S.C. 1395 et seq.) is amended by adding at the end 

5 the following new section: 

6 ‘‘MEDICARE ADVANCE DIRECTIVE CERTIFICATION

7 PROGRAM

8 ‘‘SEC. 1849. (a) IN GENERAL.— 

9 ‘‘(1) ESTABLISHMENT OF PROGRAM.—The Sec10 retary shall establish and implement an Advance Di11 rective Certification Program (in this section re12 ferred to as the ‘Program’) under which the Sec13 retary shall encourage eligible beneficiaries to adopt 

14 and maintain certified advance directives to guide 

15 the delivery of health care to such beneficiaries. The 

16 Secretary shall implement the Program not later 

17 than 3 years after the date of enactment of this sec18 tion. 

19 ‘‘(2) DEFINITIONS.—In this section: 

20 ‘‘(A) CERTIFIED ADVANCE DIRECTIVE.— 

21 The term ‘certified advance directive’ means 

22 any electronically stored statement by an eligi23 ble beneficiary who— 

24 ‘‘(i) provides instructions that outline 

25 the kind of medical treatments and care 

26 that such beneficiary would want or not 


tkelley on DSK3SPTVN1PROD with BILLS
3 

•HR 4059 IH

1 want under particular conditions, and may 

2 also include the identification of a health 

3 care proxy or legal representative to make 

4 medical treatment decisions for the bene5 ficiary if the beneficiary becomes unable to 

6 make or communicate those decisions; 

7 ‘‘(ii) is executed in accordance with 

8 the law governing advance directives of the 

9 State involved; and 

10 ‘‘(iii) is offered by an entity that has 

11 received accreditation from the Secretary 

12 under this section. 

13 ‘‘(B) ELIGIBLE BENEFICIARY.—The term 

14 ‘eligible beneficiary’ means an individual en15 rolled under this part. 

16 ‘‘(3) VOLUNTARY.—Participation in the Pro17 gram shall be voluntary with respect to the eligible 

18 beneficiary and an eligible beneficiary who has reg19 istered a certified advance directive under the Pro20 gram may terminate such directive at any time. 

21 Nothing in this section shall require an eligible bene22 ficiary to adopt or maintain a certified advance di23 rective. 

24 ‘‘(4) BEST PRACTICES.—In establishing and im25 plementing the Program, the Secretary shall conVerDate Sep 11 2014 22:09 Nov 21, 2015 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4059.IH H4059

tkelley on DSK3SPTVN1PROD with BILLS
4 

•HR 4059 IH

1 sider best practices within existing advance directive 

2 registry technologies, programs, and systems, includ3 ing web-based or cloud-based advance directive tech4 nologies, which may utilize time and date stamps, 

5 video, or other innovative measures to protect the 

6 authenticity, improve the quality, and enhance the 

7 security of such directives. 

8 ‘‘(5) ENROLLMENT AND DISENROLLMENT.— 

9 The Secretary shall establish procedures for eligible 

10 beneficiaries to enroll and disenroll under the Pro11 gram. Such procedures shall ensure that enrollment 

12 and disenrollment is available through an online 

13 process. The Secretary shall also establish proce14 dures to ensure Program participants can update or 

15 amend an advance directive in a timely and secure 

16 manner. 

17 ‘‘(6) STATE LAW.—This section shall in no way 

18 supercede, abrogate, or otherwise interfere with 

19 State law governing advance directives. Under the 

20 Program, the Secretary shall establish a process 

21 under which the Secretary is required to verify that 

22 digital advance directive vendors or other entities 

23 providing a digital advance directive participating in 

24 the program enable those using their services to 

25 complete advance directives that fully comply with 


tkelley on DSK3SPTVN1PROD with BILLS
5 

•HR 4059 IH

1 the law governing advance directives of the State in2 volved. 

3 ‘‘(7) DISPLAY OF STATUTORY AND ALTER4 NATIVE ADVANCE DIRECTIVE FORMS.—Under the 

5 Program, the Centers for Medicare & Medicaid Serv6 ices shall provide, through a clearinghouse website, 

7 links to statutory and alternative advance directive 

8 forms and a State-by-State index to such forms to 

9 allow a beneficiary to create, adopt, modify, and ter10 minate an advance directive with any content per11 mitted or required, and in any form authorized by 

12 a State, in accordance with the requirements of sub13 paragraphs (C) through (E) of subsection (e)(1) and 

14 subsection (e)(2). 

15 ‘‘(8) ACCESS IN CASES OF DISPUTE OVER

16 TREATMENT.—Under the Program: 

17 ‘‘(A) SPECIAL ACCESS.—The Secretary 

18 shall establish a process whereby, with respect 

19 to a beneficiary with a certified advance direc20 tive, a person described in subparagraph (B) 

21 may obtain access to the beneficiary’s advance 

22 directive for the purposes of viewing and shar23 ing such advance directive when— 

24 ‘‘(i) the provisions of the advance di25 rective have come into force under the apVerDate Sep 11 2014 22:09 Nov 21, 2015 Jkt 059200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4059.IH H4059

tkelley on DSK3SPTVN1PROD with BILLS
6 

•HR 4059 IH

1 plicable State’s law because the beneficiary 

2 has become incapable of making health 

3 care decisions or under other cir4 cumstances provided under State law; and 

5 ‘‘(ii) at least one person described in 

6 subparagraph (B) is questioning or dis7 puting the provision, withholding, or with8 drawal of medical treatment, food, or 

9 fluids with respect to the beneficiary. 

10 ‘‘(B) INTERESTED INDIVIDUALS.—A per11 son described in this subparagraph, with re12 spect to a beneficiary, is— 

13 ‘‘(i) any individual who is a member 

14 of any class of persons who, under the ap15 plicable State’s law, would potentially be 

16 eligible to serve as a health care decision 

17 maker for the beneficiary if an advance di18 rective had not been executed regardless of 

19 whether higher priority for such eligibility 

20 would be accorded to another individual or 

21 individuals; and 

22 ‘‘(ii) if the applicable State’s law does 

23 not designate persons or classes of persons 

24 described in clause (i), any person related 


tkelley on DSK3SPTVN1PROD with BILLS
7 

•HR 4059 IH

1 within the third degree of consanguinity or 

2 affinity to the beneficiary. 

3 ‘‘(b) REGISTRATION.— 

4 ‘‘(1) IN GENERAL.—The Secretary shall estab5 lish procedures for an eligible beneficiary to register 

6 such beneficiary’s adoption of a certified advance di7 rective under the Program. Such procedures shall 

8 ensure that registration is available through an on9 line process. The Secretary shall also establish pro10 cedures to ensure Program participants can update 

11 previously registered information that is no longer 

12 accurate and indicate that an advance directive has 

13 been terminated. 

14 ‘‘(2) REQUIRED INFORMATION.—In addition to 

15 such other information as the Secretary may deem 

16 appropriate, an eligible beneficiary seeking to reg17 ister a certified advance directive under the Program 

18 shall indicate where the advance directive is main19 tained. 

20 ‘‘(3) REGISTRATION PERIODS.—The procedures 

21 established under paragraph (1) shall provide that 

22 registration under the Program shall occur during— 

23 ‘‘(A) an eligible beneficiary’s initial enroll24 ment under an MA plan under part C as deVerDate Sep 11 2014 22:09 Nov 21, 2015 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4059.IH H4059

tkelley on DSK3SPTVN1PROD with BILLS
8 

•HR 4059 IH

1 scribed in paragraph (1) of section 1851(e); 

2 and 

3 ‘‘(B) the annual, coordinated election pe4 riod under paragraph (3) of such section. 

5 ‘‘(4) PRIVACY AND SECURITY.— 

6 ‘‘(A) IN GENERAL.—The Secretary shall 

7 ensure that all aspects of the registration sys8 tem comply with the Federal regulations (con9 cerning the privacy of individually identifiable 

10 health information) promulgated under section 

11 264(c) of the Health Insurance Portability and 

12 Accountability Act of 1996 subject to the access 

13 authorized under subsection (a)(8) and sub14 section (c)(2)(D). 

15 ‘‘(B) ACCESS.—The Secretary shall utilize 

16 standardized data protections and privacy 

17 standards, including the Federal regulations de18 scribed in paragraph (1), to ensure that the 

19 registration record of an eligible beneficiary can 

20 only be accessed by— 

21 ‘‘(i) the beneficiary, through the proc22 ess established under paragraph (1); 

23 ‘‘(ii) those authorized to access the 

24 advance directive under subsection (a)(8) 

25 and subsection (c)(2)(D); and 


tkelley on DSK3SPTVN1PROD with BILLS
9 

•HR 4059 IH

1 ‘‘(iii) providers of services and sup2 pliers participating under this title, 

3 through a process established by the Sec4 retary. 

5 ‘‘(c) ACCREDITATION.— 

6 ‘‘(1) IN GENERAL.—Under the Program, the 

7 Secretary shall— 

8 ‘‘(A) grant accreditation to advance direc9 tive vendors and other entities providing ad10 vance directives that meet the accreditation cri11 teria established under paragraph (2); and 

12 ‘‘(B) establish a process whereby advance 

13 directive vendors and other entities providing 

14 advance directives may obtain accreditation 

15 under this subsection. 

16 ‘‘(2) ACCREDITATION CRITERIA.—The Sec17 retary, in consultation with the General Accounting 

18 Office, shall establish accreditation criteria for ad19 vance directive vendors and other entities providing 

20 advance directives that seek to offer advance direc21 tives to be certified under the Program. Such cri22 teria shall consist of the following: 

23 ‘‘(A) PROCESS FOR ADOPTING ADVANCE

24 DIRECTIVE.—The advance directive vendor or 

25 other entity providing an advance directive shall 


tkelley on DSK3SPTVN1PROD with BILLS
10 

•HR 4059 IH

1 allow a beneficiary to create, adopt, modify, and 

2 terminate an advance directive through an on3 line process. 

4 ‘‘(B) VENDORS.—The advance directive 

5 vendor or other entity providing an advance di6 rective shall comply with an annual quality re7 view to be conducted by the Secretary. 

8 ‘‘(C) USE OF STATUTORY AND ALTER9 NATIVE ADVANCE DIRECTIVE FORMS.—The ad10 vance directive vendor or other entity providing 

11 an advance directive shall enable a beneficiary 

12 to access, complete, modify, and adopt any ad13 vance directive applicable to the State indicated 

14 by the beneficiary who is posted as provided 

15 under subparagraphs (C) through (E) of sub16 section (e)(1) and of subsection (e)(2). 

17 ‘‘(D) ACCESS.—The advance directive ven18 dor or other entity providing an advance direc19 tive shall maintain advance directives in such a 

20 way that— 

21 ‘‘(i) an eligible beneficiary who has 

22 adopted an advance directive with such 

23 vendor or entity and any family member, 

24 legal representative, or health care proxy 

25 legally designated by such beneficiary has 


tkelley on DSK3SPTVN1PROD with BILLS
11 

•HR 4059 IH

1 direct, near real-time online access to the 

2 beneficiary’s advance directive for purposes 

3 of viewing and sharing such advance direc4 tive; 

5 ‘‘(ii) in the case of an eligible bene6 ficiary who has adopted an advance direc7 tive with such vendor or entity or any fam8 ily member, legal representative, or health 

9 care proxy legally designated by such bene10 ficiary who is unable or unwilling to use 

11 the online access under subparagraph (A), 

12 such individual is able to obtain a hard 

13 copy of the beneficiary’s advance directive 

14 for the purposes of viewing and sharing 

15 such advance directive; and 

16 ‘‘(iii) providers of services and sup17 pliers participating under this title have 

18 near real-time online access to the advance 

19 directive of an eligible beneficiary who has 

20 adopted an advance directive with such 

21 vendor or entity. 

22 ‘‘(E) PRIVACY PROTECTIONS.— 

23 ‘‘(i) IN GENERAL.—The advance di24 rective vendor or other entity providing an 

25 advance directive shall comply with the 


tkelley on DSK3SPTVN1PROD with BILLS
12 

•HR 4059 IH

1 Federal regulations (concerning the privacy 

2 of individually identifiable health informa3 tion) promulgated under section 264(c) of 

4 the Health Insurance Portability and Ac5 countability Act of 1996 (42 U.S.C. 

6 1320d–2 note), subject to the access au7 thorized under subparagraph (D) and sub8 section (a)(8). 

9 ‘‘(ii) ACCESS.—Such vendor or entity 

10 shall utilize standardized data protections 

11 and privacy standards, including the Fed12 eral regulations described in clause (i), to 

13 ensure that the content of an eligible bene14 ficiary’s advance directive is owned and 

15 maintained by the beneficiary and can only 

16 be accessed by those authorized to access 

17 the advance directive under subparagraph 

18 (D) and subsection (a)(8). 

19 ‘‘(F) SECURITY AND TESTING.—The ad20 vance directive vendor or other entity providing 

21 an advance directive shall certify that— 

22 ‘‘(i) all data management and data 

23 transfer elements involved in adopting, 

24 maintaining, and accessing the advance di25 rective have successfully passed rigorous 


tkelley on DSK3SPTVN1PROD with BILLS
13 

•HR 4059 IH

1 independent testing regarding standards of 

2 timeliness, accuracy, and efficiency; 

3 ‘‘(ii) the data management and data 

4 transfer elements involved in adopting, 

5 maintaining, and accessing the advance di6 rective meet widely accepted industry secu7 rity standards; and 

8 ‘‘(iii) the system that provides access 

9 to the advance directive has passed real10 time tests simulating a realistic volume of 

11 beneficiaries and providers accessing ad12 vance directives simultaneously. 

13 ‘‘(G) CERTIFIED ADVANCE DIRECTIVES.— 

14 The advance directive vendor or other entity 

15 providing an advance directive shall agree to 

16 offer certified advance directives (as defined in 

17 subsection (a)(2)(A)). 

18 ‘‘(H) BENEFICIARY SURVEYS.— 

19 ‘‘(i) IN GENERAL.—The advance di20 rective vendor or other entity providing an 

21 advance directive shall agree to administer 

22 annual beneficiary surveys on the informa23 tion described in clause (ii) and submit the 

24 results of such surveys to the Centers for 

25 Medicare & Medicaid Services. 


tkelley on DSK3SPTVN1PROD with BILLS
14 

•HR 4059 IH

1 ‘‘(ii) INFORMATION.—The information 

2 described in this clause, with respect to an 

3 annual beneficiary survey and certified ad4 vance directive of a beneficiary, is the fol5 lowing: 

6 ‘‘(I) Whether the beneficiary had 

7 to pay any third party for the cre8 ation, storage, or retrieval of the cer9 tified advance directive. 

10 ‘‘(II) Whether the beneficiary 

11 had a health care encounter or emer12 gency that required the location, ac13 cess, retrieval, or consultation of the 

14 certified advance directive and if so, 

15 whether the certified advance directive 

16 was accessible in online and in near 

17 real-time, as required under this sec18 tion. 

19 ‘‘(III) Whether the certified ad20 vance directive was actionable. 

21 ‘‘(IV) Whether medical personnel 

22 followed the certified advance direc23 tive. 

24 ‘‘(d) INCENTIVE.— 


tkelley on DSK3SPTVN1PROD with BILLS
15 

•HR 4059 IH

1 ‘‘(1) IN GENERAL.—The Secretary shall make a 

2 one-time payment of the amount specified in para3 graph (2) to each eligible beneficiary who adopts a 

4 certified advance directive and registers such direc5 tive with the Program. 

6 ‘‘(2) AMOUNT.— 

7 ‘‘(A) IN GENERAL.—For purposes of para8 graph (1), the amount specified in this para9 graph is— 

10 ‘‘(i) for a beneficiary who registers a 

11 certified advance directive with the Pro12 gram in 2015, $75; or 

13 ‘‘(ii) for a beneficiary who registers a 

14 certified advance directive with the Pro15 gram in a subsequent year, the amount 

16 specified in this paragraph for the pre17 ceding year increased by the percentage in18 crease in the Chained Consumer Price 

19 Index for All Urban Consumers (as pub20 lished by the Bureau of Labor Statistics of 

21 the Department of Labor) over the pre22 ceding year. 

23 ‘‘(B) ROUNDING.—If any amount deter24 mined under subparagraph (A) is not a multiple 


tkelley on DSK3SPTVN1PROD with BILLS
16 

•HR 4059 IH

1 of 10 cents, such amount shall be rounded to 

2 the nearest multiple of 10 cents. 

3 ‘‘(3) ADMINISTRATION.—The Secretary shall, 

4 through a full notice and comment rulemaking proc5 ess, establish procedures for— 

6 ‘‘(A) making the incentive payment di7 rectly to the eligible beneficiary or a personal 

8 account maintained by the beneficiary at a fi9 nancial institution that has been designated by 

10 the beneficiary, and ensuring that no other enti11 ty receives the payment on the beneficiary’s be12 half; and 

13 ‘‘(B) ensuring that a beneficiary does not 

14 receive an incentive payment under this section 

15 more than once. 

16 ‘‘(e) EDUCATION AND OUTREACH.— 

17 ‘‘(1) IN GENERAL.—The Secretary shall provide 

18 for— 

19 ‘‘(A) the inclusion of the statement set 

20 forth in paragraph (3) in the Medicare and You 

21 handbook under section 1804 and on a clear22 inghouse website linked to the Internet website 

23 of the Centers for Medicare & Medicaid Serv24 ices; 


tkelley on DSK3SPTVN1PROD with BILLS
17 

•HR 4059 IH

1 ‘‘(B) the promotion of the benefits of elec2 tronic advance directives services, as they be3 come available, through the use of mass com4 munications and other means; 

5 ‘‘(C) the inclusion, under the heading 

6 ‘Statutory Advance Directive Forms’, of any 

7 relevant forms, whether mandatory or optional, 

8 specified in the statues or regulations of the 

9 States to be displayed on a clearinghouse 

10 website; 

11 ‘‘(D) the inclusion, under the heading ‘Al12 ternative Advance Directive Forms,’ on a sepa13 rate clearinghouse website, and in accordance 

14 with paragraph (2)— 

15 ‘‘(i) of other advance directive forms 

16 submitted to the Secretary by individuals 

17 and groups in an electronic format speci18 fied by the Secretary for which the submit19 ting entity includes, for each form sub20 mitted, an opinion by an attorney licensed 

21 to practice in the relevant State dem22 onstrating that the submitted form com23 plies with the law of that State; and 

24 ‘‘(ii) of the following disclaimer, which 

25 shall be prominently posted on the website: 


tkelley on DSK3SPTVN1PROD with BILLS
18 

•HR 4059 IH

1 ‘This website includes for your consider2 ation alternative advance directive forms 

3 submitted by individuals or groups reflect4 ing different perspectives on advance 

5 health care decisions which you may wish 

6 to review before completing your own ad7 vance directive.’; and 

8 ‘‘(E) the inclusion of a user friendly index 

9 on the clearinghouse website by State and, in 

10 the case of the ‘Alternative Advance Directive 

11 Forms’, by the name of the provider, so that a 

12 user may readily access those statutory and al13 ternative forms. 

14 ‘‘(2) ALTERNATIVE ADVANCE DIRECTIVE

15 FORMS.— 

16 ‘‘(A) IN GENERAL.—For purposes of para17 graph (1)(D), the following shall apply: 

18 ‘‘(i) Not later than 60 days after re19 ceiving an advance directive form sub20 mitted under such paragraph, the Sec21 retary shall either post the submitted form 

22 on a clearinghouse website or provide to 

23 the submitting entity a detailed expla24 nation of the basis for the Secretary’s de25 termination that the submitted form does 


tkelley on DSK3SPTVN1PROD with BILLS
19 

•HR 4059 IH

1 not comply with relevant State or Federal 

2 law, which determination shall be subject 

3 to judicial review under section 702 of title 

4 5 of the United States Code; and 

5 ‘‘(ii) the Secretary shall either remove 

6 or refuse to post any submitted form if 

7 provided with an official determination by 

8 the Attorney General of the applicable 

9 State that the form is not in compliance 

10 with State law, subject to applicable State 

11 law described in subparagraph (B). 

12 ‘‘(B) STATE LAW DESCRIBED.—For pur13 poses of subparagraph (A), State law described 

14 in this subparagraph is— 

15 ‘‘(i) a ruling by a court of the applica16 ble State, or by a Federal court applying 

17 that State’s law, subject to subsequent rul18 ings by a court or courts with authority to 

19 supercede that ruling; or 

20 ‘‘(ii) a statute or regulation of the ap21 plicable State that provides for a specific 

22 procedure for officially determining wheth23 er particular advance directive forms com24 ply with State law. 


tkelley on DSK3SPTVN1PROD with BILLS
20 

•HR 4059 IH

1 ‘‘(3) STATEMENT.—For purposes of paragraph 

2 (1)(A), the statement included in this paragraph is 

3 the following statement, with appropriate insertions 

4 in the bracketed segments updated at least annually: 

5 ‘‘WHY YOU MAY WANT TO CONSIDER AN ‘AD6 VANCE DIRECTIVE’ Do you ever worry what would 

7 happen if you became unable to make health care decisions 

8 for yourself because of an illness or injury? That’s what 

9 an ‘advance directive’ is for. You can use it to give direc10 tions for your health care providers and family about your 

11 health care wishes that are to be followed if you are no 

12 longer able to speak for yourself. You can also name some13 one you trust, like a family member or friend, to give 

14 health care directions for you when you can’t do so your15 self. 

16 ‘‘You should consider carefully who to choose to 

17 speak for you and what directions you want to give to en18 sure your representative clearly reflects your own values 

19 and treatment preferences. You should not feel pressured 

20 to violate your own values and preferences, and you are 

21 entitled to implement them without discrimination based 

22 on age or degree of disability. 

23 ‘‘There are many resources to help you. 

24 ‘‘By choosing the name of a state at [INSERT name 

25 of webpage for the index provided in paragraph 4 of this 


tkelley on DSK3SPTVN1PROD with BILLS
21 

•HR 4059 IH

1 subsection and its URL (and, on the clearinghouse 

2 website, include a hyperlink to it)], you can find sample 

3 advance directives for that state. You can see any sample 

4 or required forms given in state law, as well as others from 

5 individuals or groups with different viewpoints on advance 

6 health care decisions which you may wish to review before 

7 completing your own advance directive. 

8 ‘‘Below is contact information for accredited vendors 

9 who will arrange for your advance directive to be confiden10 tially kept online, where it can be seen by doctors who 

11 are treating you so they are made aware of your wishes. 

12 You can also give permission to certain other people, like 

13 family members or friends, you want to be able to get a 

14 copy of your advance directive. If a disagreement about 

15 your treatment develops, depending on your state’s law 

16 certain other people may also be allowed to see it. 

17 ‘‘These vendors can also help you create an advance 

18 directive online or with paper documents, if you wish. On19 line directives allow you to change or cancel one that no 

20 longer fits with your wishes in a more timely manner. 

21 ‘‘[INSERT, in alphabetical order, the names and 

22 contact information for currently accredited advance di23 rective vendors (and, on the clearinghouse website, 

24 hyperlinks to their websites).] 


tkelley on DSK3SPTVN1PROD with BILLS
22 

•HR 4059 IH

1 ‘‘Although any adult who is capable of doing so can 

2 use these resources to complete an advance directive at 

3 any time, Medicare beneficiaries are particularly encour4 aged to do so when enrolling in Medicare or during the 

5 annual enrollment period when you can choose among dif6 ferent Medicare health insurance alternatives. 

7 ‘‘In addition, some Medicare Advantage plans or sup8 plemental insurance plans may offer a financial incentive 

9 or other additional benefits for creating an advance direc10 tive online. 

11 ‘‘By completing an advance directive you can not only 

12 make it more likely that your wishes about health care 

13 will be known if you are unable to tell them at the time, 

14 but also spare family, friends, and doctors the difficulty 

15 of trying to figure out what you would have wanted. These 

16 are matters of the highest importance that can affect life17 or-death decisions, as well as your future comfort and 

18 well-being. You are encouraged to think about them care19 fully, and give serious consideration to recording your 

20 wishes in an advance directive.’’. 

Æ 


tkelley on DSK3SPTVN1PROD with BILLS